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When a person needs extra care but not necessarily from a hospital, a nursing home may be a suitable option for them. Most nursing homes provide extra care throughout the day. The care that you will receive will vary depending on your medical condition or the help that you will need.
So a common question many people have is, “does Medicare cover nursing home care?” In this article, we answer that question in clear, plain English. You will also find the average costs of nursing home care, as well as other helpful info.
Does Medicare Cover Nursing Home Care?
The short answer is yes; Medicare will cover the cost of nursing home care. But not 100% of the time. As is often the case with Medicare, certain conditions have to be met for Medicare to pay for your nursing home care. Below we look at what these are so you know what to expect.
Original Medicare (Medicare Part A and Part B) provides coverage for nursing home care. Coverage for nursing home care is provided by Medicare Part A. However, Medicare Part A does not provide coverage for nursing home care when the patient only needs custodial care. This custodial care includes the following:
- Going to the bathroom
Medicare Part A also does not provide coverage for long-term stays in a skilled nursing facility. Medicare Part A only provides coverage for short-term stays in a skilled nursing facility.
For Medicare Part A to provide coverage for your nursing home care, there are some conditions that have to be followed. These conditions are:
- You still have days left in your benefit period
- You had a qualifying hospital stay
- The patient must be admitted to the skilled nursing facility within 30 days of their discharge from the hospital
- Your healthcare provider must determine why you need daily nursing home care and what kind of care you need
- You need daily care for your medical condition that was treated in the hospital or a new medical condition that you developed in a skilled nursing facility that is different from the condition that you have while in a hospital
- You will receive your daily care and needs in a skilled nursing facility
- The skilled nursing facility is Medicare-approved
Medicare Part A provides coverage for 100 days at a skilled nursing facility. Some of the services that Medicare Part A covers while staying in a skilled nursing facility consist of:
- Dietary counseling along with other nutrition services
- Medical supplies and equipment
- Nursing home care
- Social work services suited to your needed medical care
- Semi-private room
- Occupational therapy
- Physical therapy
- Speech-language pathology
Medicare Part A also provides coverage for “swing bed services” which is skilled nursing care that you receive in an acute-care hospital.
Part C Coverage for Nursing Home Care
Medicare Advantage plans (Medicare Part C) also provide coverage for nursing home care. They cover everything Original Medicare covers, as well as some additional benefits. However, exactly what it covers and what your out-of-pocket costs are will vary depending on the specifics of your plan.
As with Medicare Part A, Medicare Part C also does not cover custodial care.
How Much Does Nursing Home Care Cost?
Staying in a private room in a skilled nursing facility may cost around $290 per day and $8,800 per month. On the other hand, staying in a semi-private room costs around $255 per day and $7,800 per month.
Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.
Additional Info on Medicare Coverage
This article is part of our series on “What does Medicare cover?”
Also, you can check out other articles in this series including: Does Medicare cover wheelchairs?